With progress both in understanding of the pathology and pathophysiology of heart valve diseases, and especially of the mitral and tricuspid valves, along with ever-improving surgical skills and technologies, the search for solutions to the disturbing and up to now unsolved problems of treating those valves is steadily increasing. Presently such solutions have involved suturing of a variety of configurations of open and closed rings in association with the valve being repaired. These rings have ranged from very firm shapes to Dacron bands having no stable configuration. Generally, over the past decades, the following two major facts have emerged.
1. Regardless of the ring configuration, its core-materials and/or its pliability, the general technique of using surgical sutures to secure the ring in place, has not changed. The time required to suture a ring in place varies somewhat from surgeon to surgeon but remains more or less the same.
2. A major drawback of the current technique is the inability of the surgeon to make any further change of the ring's configuration once the ring has been sutured to the heart valve tissue. In other words, if the final result in the eyes of the surgeon is less than optimal, he cannot do much to improve the surgical results of his repair once the ring is in place unless he should cut the sutures, and either partially remove the ring or entirely re-implant it.
The implantation system illustrated and described in my published International Patent Application No. WO 03/053289, shows annuloplasty rings and methods for implantation which are designed to allow stapling of a fenestrated ring in place and in this manner reduce the time required for the surgeon to implant an annuloplasty ring while the patient is connected to the heart-lung machine. The disclosure of this application is incorporated herein by reference. However, further improvements that would allow a surgeon to make final, small changes to an annuloplasty ring once it has been secured to the heart valve tissue remain a desire of cardiac surgeons.